Methods and systems for identifying a preferred pacing configuration for a multi-electrode implantable cardiac electrotherapy device

Abstract

Methods and systems of identifying an electrode or combination of electrodes of a multi-electrode device for pacing include selecting a first electrode or electrode combination as a first candidate; delivering a pacing pulse through the first candidate and determining a measurement based on sensed cardiac electrical activity resulting from the first candidate pacing; selecting a second candidate; delivering a pacing pulse through the second candidate and determining a measurement based on sensed cardiac electrical activity resulting from the second candidate pacing; comparing the measurement for the first and second candidates; and identifying the first or second candidate for pacing based on the comparison. The measurement may be one or more of activation time ΔT act , activation recovery interval (ARI), a fractioned electrogram width, and a standard deviation of a fractioned electrogram feature.

1. A method of identifying an electrode or combination of electrodes of a multi-electrode implantable cardiac electrotherapy device for pacing, said method comprising:
 selecting a first electrode or combination of electrodes as a first candidate to be used for pacing; 
 determining measurements comprising activation time ΔT act  and activation recovery interval (ARI) based on sensed cardiac electrical activity, for the first candidate; 
 selecting a second electrode or combination of electrodes as a second candidate to be used for pacing; 
 determining measurements comprising activation time ΔT act  and activation recovery interval (ARI) based on sensed cardiac electrical activity, for the second candidate; 
 comparing the measurements for the first and second candidates; and 
 identifying one of the first and second candidates for pacing based on the comparisons by identifying the candidate with at least one of a shortest activation time ΔT act  and a smallest ARI. 
 
     
     
       2. The method of  claim 1  wherein identifying one of the first and second candidates for pacing is further based on a desired type of pacing. 
     
     
       3. The method of  claim 1  wherein determining an activation time ΔT act  for either of the first and second candidates comprises:
 delivering a pacing pulse to the candidate; 
 for each of a plurality of non-candidate electrodes:
 sensing cardiac activity at the non-candidate electrode; 
 measuring the time between the delivery of the pacing pulse to the candidate and the sensing of cardiac activity at the non-candidate electrode; 
 
 comparing the measured times; and 
 selecting the largest measured time as the activation time ΔT act  for the candidate electrode. 
 
     
     
       4. The method of  claim 1  wherein determining the ARI for either of the first and second candidates comprises:
 delivering a pacing pulse to the candidate; 
 for each of a plurality of non-candidate electrodes positioned in or on a ventricle:
 sensing cardiac activity at the non-candidate electrode; 
 measuring the time between the delivery of the pacing pulse to the candidate and the end of recovery of the sensed cardiac activity at the non-candidate electrode; 
 
 for each of a plurality of non-candidate electrodes positioned in or on an atria:
 sensing cardiac activity at the non-candidate electrode; 
 determining the time between the delivery of the pacing pulse to the candidate and the sensing of cardiac activity at the non-candidate electrode; 
 summing the determined time and a predetermined effective refractory period corresponding to the non-candidate electrode, 
 
 comparing the measured and summed times to each other; and
 selecting the smallest of the measured and summed times as the ARI for the candidate electrode. 
 
 
     
     
       5. A method of identifying an electrode or combination of electrodes of a multi-electrode implantable cardiac electrotherapy device for pacing, said method comprising:
 selecting a first electrode or combination of electrodes as a first candidate to be used for pacing based on a desired pacing type; 
 determining measurements comprising activation time ΔT act  and activation recovery interval (ARI) based on sensed cardiac electrical activity, for the first candidate; 
 selecting a second electrode or combination of electrodes as a second candidate to be used for pacing based on the desired pacing type; 
 determining measurements comprising activation time ΔT act  and activation recovery interval (ARI) based on sensed cardiac electrical activity, for the second candidate; 
 weighting a result of at least one of the comparison of the activation times ΔT act  and the comparison of the ARIs based on the desired type of pacing; 
 comparing the measurements for the first and second candidates; and 
 identifying one of the first and second candidates for pacing based on the comparison. 
 
     
     
       6. The method of  claim 5  wherein:
 when the desired type of pacing is cardiac resynchronization therapy, the activation times ΔT act  result is weighted more heavily than the ARI result; and 
 when the desired type of pacing is prevention type pacing, the ARI result is weighted more heavily than the activation times ΔT act  result.